The long-term effects of cocaine exposure during pregnancy and the effects of cocaine use on the child's environment are major public health concerns. However, very little information exists regarding these effects. This is a proposal to define the long-term effects of prenatal cocaine exposure with a large, well-established cohort of substance-using women and their offspring. In this unique study of prenatal cocaine use, women were enrolled early in pregnancy, trimester-specific information was collected, and the children have been assessed at regular intervals through age 10. This study has exceptional follow-up rates, a detailed assessment of all substance use in the prenatal and postpartum periods, careful measurement of other characteristics, particularly environmental variables, and a comprehensive child assessment battery. We have demonstrated that prenatal cocaine exposure has consistent effects on the development of the CNS. At birth, we found neurological and neurobehavioral effects. At 1 and 3 years of age, children exposed to cocaine were reported to be fussier and more difficult. At 3 and 7 years, prenatal cocaine use significantly predicted lower lQ scores and increased behavior problems. There was also a significant interaction between age and prenatal exposure, revealing a significant decline in lQ scores between 3 and 7 years among the cocaine-exposed children. At 10 years, prenatal cocaine exposure predicted poorer neuropsychological performance, increased behavior and attention problems, and increased symptoms of depression. Thus, through the age of 10 years, children exposed to cocaine show increased behavior and attention problems, changes in temperament and mood, and cognitive and neuropsychological deficits. There were also significant effects of prenatal cocaine exposure on growth at each phase. This is a application to assess the cohort at 14 years of age. This is an important developmental period as it is the time of transition into high school, a time of change and stress, and of introduction into the social and substance-using world of older adolescents. It is also an important time for physical and CNS maturation. The conjunction of these elements may be particularly critical for the prenatally exposed adolescents who by age 10 were already showing neuropsychological deficits, behavior and attention problems, and mood disturbances. Our hypotheses are: (1) at age 14, the effects of prenatal cocaine exposure will continue to be manifested as deficits in growth, cognition (problem solving and mental flexibility), behavior and attention problems, and mood; and (2) antecedent risk factors, such as a poor home environment, parental substance use, and conduct disorder, will predict drug and alcohol use among the 14-year-olds.